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Eating Disorders – article by Emma Thomas
Eating disorders affect over 900,000 Australians each year. The mortality rate for eating
disorders is of great concern, and is the highest of the psychiatric illnesses (over 20%), given
its physiological complications and link with suicide. Around 1900 Australians died last year
as a result of an eating disorder. Furthermore, they are also strongly associated with other
distressing mental disorders such as anxiety, depression, personality disorders and
substance abuse issues. Contributing to the high mortality rate is the reluctance to seek
help, with less than 30% of people experiencing an eating disorder seeking help for their
disorder.
In early March 2015, the Deloitte Access Economics report stated that eating disorders
would cost over $27 billion of taxpayer money over the next 10 years, while better
intervention initiatives would cost only $2.8 billion over this period.
It is not surprising, therefore, that one of the key actions from the Mental Health
Commission’s 2015 strategic plan is to ensure adequate training is provided to all staff in
mental health services in the recognition, assessment, referral pathways and treatment of
eating disorders. A further outcome from the plan is to prioritise the development of
community-based care models. Both of these actions will promote earlier intervention and
will help people to get more effective help in a timely manner.
What is an eating disorder?
An eating disorder is a serious mental health illness which involves having an unhealthy
preoccupation with eating and/or exercise and body shape/weight. It is important to
understand that an eating disorder can be extremely dangerous, and should be
acknowledged as distinctive from a diet, fad, or attempt to seek attention.
There are a number of different types of eating disorders, the most common being Anorexia
Nervosa, Bulimia Nervosa and Binge Eating Disorder. These will be discussed in greater
detail later in the article.
How do I know if my child has an eating disorder?
There are a number of different behavioural, physical and psychological warning signs for
parents to watch out for. The Butterfly Foundation outlines the below warning signs for
parents. If your child is experiencing several of the below, it is important to seek help from a
professional.
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Withdrawal from social events and activities that they used to enjoy
A focus on diets, calories, health and particular foods. They might talk about wanting
to be healthier or fitter and become obsessive about checking the nutritional content
of what they are eating.
They might become irritable or anxious around dinner time. They may refuse to eat
certain foods or whole food groups.
Complaints about the way they look, e.g. “I’m ugly” or “I’m fat”, or negative comments
about their abilities, e.g. “I’m hopeless”
Frequent weight changes or rapid weight loss
Change in clothing style such as wearing baggy or oversized clothing
Causes of Eating Disorders
There is no single cause of developing an eating disorder. However, the National Eating
Disorders Collaboration Australia has identified certain risk factors:
Emma Thomas
Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
Genetic vulnerability
There is some evidence links the inheritance of certain genes that relate to appetite, mood,
metabolism, food intake and reward-pleasure responses. However, the biological cause of
eating disorders is not clear cut, due to the fact that studies are conducted post development
of an eating disorder, which could have had an impact on the findings, therefore making it
difficult to establish a direct ‘cause and effect’ relationship.
Psychological factors
Certain personality traits are known to be linked to the development of eating disorders,
particularly to that of Anorexia Nervosa and Bulimia Nervosa:
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obsessive-compulsiveness
neuroticism
core low self-esteem
negative emotionality
perfectionism
harm avoidance
traits associated with avoidant personality disorder
However, once again the direct ‘cause and effect’ relationship is difficult to identify due to the
impact that eating disorders have on the people’s thoughts, emotions and behaviours.
Socio-cultural influences
Those who take on the Western beauty ideal of the “perfect body” can be at risk of
developing an eating disorder. Images in the media show unattainable images of beautiful
slim women, and handsome muscled men, which encourage body dissatisfaction.
What can I do to help my child develop a healthy relationship with food, exercise and
weight?
Parents play a key role in their child’s relationship with food and body image. Here are some
tips for parents from Kasey Edwards, best-selling author and expert in body image among
young girls:
1. Never talk about body weight
Kasey advises never to talk about your own weight or your looks at all in a negative manner.
When others talk about weight in front of your children, do your best to neutralise it. This will
help to teach them that looks and weight are unrelated to self-worth.
2. Never talk about food in terms of calories or what’s fattening
Speak instead about the nutritional value of food.
3. Don’t ban certain foods
It is important not to classify foods into black and white categories of good and bad, as this is
not the case with most foods. Some processed foods are reasonable at times as they taste
good and are part of certain social rituals (e.g. birthday cake) but don’t contribute to making
us fit and healthy and strong. Classifying foods as “bad” can create closet eaters who sneak
away these “bad” foods and eat them in secret.
4. Try limiting “rules” around food
Kasey suggests having only one rule such as “you must eat something of everything on your
plate” to ensure a wide variety of nutrients. Additionally, she does not recommend forcing a
child to eat if they do not feel hungry as this encourages them to be in charge of their own
appetite and can avoid food wars or dining table power struggles.
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
5. Focus on how bodies work rather than how they look
Celebrate the amazing things one can do with their body — such as running, jumping,
skipping, and rolling. This will help to teach them to value their body for what it can do
instead of what it looks like.
What about if my child gets diagnosed with an eating disorder?
The National Eating Disorders Collaboration of Australia Offers 7 tips for families and carers
of those people with an eating disorder:
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Read up on eating disorders and learn as much as you can about how to treat them
better. This will also enable you to better understand their point of view and what
they are going through.
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Remember who the person is – they are more than just their illness. Help them to
regain their sense of identity outside of the disorder.
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Open the lines of communication. Ensure you express how you are feeling but avoid
judgement and negativity. Also encourage them to express their feelings openly and
honestly.
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Try to stay positive in your own mind and about them. Talk about future plans and
point out their positive attributes and strengths to build their self-esteem.
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Ensure you are engaging in self-care. Acknowledge that you have a tough role to
play and make time to relax and do things to restore your energy so you are in better
shape to care for your loved one.
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Be patient and try to remember that recovery from an eating disorder is a slow
process and takes time and perseverance.
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Get professional support for yourself and for your loved one. This will help ease the
stress that is associated with suffering from and caring for someone with an eating
disorder.
What are my rights?
You have the right to medical treatment if you fear for the life of your child. The Australian
Government Department of Health states that health professionals are legally required to
ensure safety, as they have a 'duty of care'. For example, involuntary admission into
hospital, which is covered by the Mental Health Act.
Even if your child doesn’t want help, when a person with an eating disorder refuses
treatment, parents or carers may obtain a 'legal order' that allows them to take temporary
control over the patient and make decisions on their behalf to authorise medical or
psychiatric treatments. This is of course used only for the purpose of saving a life when all
other options fail.
In Australia, persons over the age of 14 can seek a confidential medical consultation. If your
child is younger than 14 then you will be included in all discussions about your child’s health.
For those over 14, only that information which your child agrees to share can be shared by
the health professional.
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
Types of Eating Disorders
The Mental Health Association of NSW outlines the following types of eating disorders, their
specific symptoms, and possible treatments:
Anorexia Nervosa
People who intentionally starve themselves may be experiencing an eating disorder called
anorexia nervosa. This disorder, which often begins in young people around the time of
puberty, involves extreme weight loss - at least 15% below the individual's normal body
weight. Some people with the disorder may look emaciated however are convinced they are
overweight. At times they must be hospitalised to prevent starvation. People with anorexia
typically starve themselves, even though they may experience severe hunger pains. One of
the most frightening aspects of the disorder is that people with anorexia continue to think
they are overweight even when they are exceptionally thin. For reasons not yet understood,
they can become terrified of gaining any weight.
Food and weight can become obsessions. For some, the compulsiveness shows up in
strange eating rituals or the refusal to eat in front of others. It is not uncommon for people
with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not
partake in the meals themselves. They may adhere to strict exercise routines to keep off
weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with
anorexia often become impotent.
Specific Symptoms of this Disorder
A person who suffers from this disorder is typically characterised by their refusal to maintain
a body weight, which is consistent with their build, age and height. The individual usually
experiences an intense and overwhelming fear of gaining weight or becoming fat. This fear
is regardless of the person's actual weight, and will often continue even when the person is
near death from starvation. It is related to a person's poor self-image, which is also a
symptom of this disorder. The individual suffering from this disorder believes that their body
weight, shape and size is directly related to how good they feel about themselves and their
worth as a human being. People with this disorder often deny the seriousness of their
condition and cannot objectively evaluate their own weight.
Physical Effects
 Chronic indigestion
 Loss of motivation
 Chemical imbalances
 Severe sensitivity to the cold
 Loss or thinning of hair
 Skin and nail problems
 Growth of fine body hair known as ‘lanugo’
 Severe weight loss
Treatment
The treatment of this disorder is often difficult. This is due to the insidious nature of the
disorder that wreaks havoc not only with the body, but just as seriously with the individual's
negative self-perception. Starvation is not an immediate concern of most individuals who
present with this disorder, but body weight and nutrition should be thoroughly evaluated at
the onset of therapy. A complete medical examination is usually warranted to evaluate the
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
person's health and medical status. Underweight individuals often experience many medical
complications.
The first line treatment for people experiencing anorexia nervosa is a combination of a
structured eating plan with nutrition and psychotherapy.
Psychotherapy
Psychotherapy needs to focus on a number of issues after a therapeutic, trusting
relationship has been established. The most powerful issue is the obsession with body
image, which is also the most difficult to change.
Hospitalisation
Hospitalisation of anybody experiencing mental distress can often be a confusing and
emotionally wrought decision. Family members or significant others may need to intervene in
the person life to ensure they do not starve themselves to death. In these cases,
hospitalisation is not only necessary but also a prudent treatment intervention. Family
members should be aware that individuals who have anorexia nervosa will often resist
treatment of any sort, especially hospitalisation. It is important, therefore, to come to an
agreement about the need for such a step and not be swayed by the person's pleas for
seeking alternative treatment options. Often these have already been tried with no success.
Medications
Some medications can be extremely helpful in treatment of a person with anorexia nervosa.
As always, the medication should be carefully monitored, especially since the person may be
vomiting which may impact on the medication's effectiveness. A trusting and honest
relationship must be established between the physician and the individual or medication
compliance will almost certainly become an issue.
Anti-depressants (selective serotonin re-uptake inhibitors such as Prozac or Zoloft) are the
usual drug treatment and may speed up the recovery process. Chlorpromazine may be
beneficial for those individuals experiencing severe obsessions and increased anxiety and
agitation.
Self-Help
Self-help support groups are an especially powerful and effective means of ensuring the
engagement in long-term treatment and decrease the rate of relapse to starving behaviours.
Individuals find they can share ideas and experiences with one another, obtain objective
feedback about body image and find increased social support. Many support groups exist
within communities throughout the world that are devoted to helping individuals with this
disorder share their common experiences and feelings.
Bulimia Nervosa
People with bulimia nervosa consume large amounts of food and then rid their bodies of the
excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising
obsessively. Some people use a combination of all these forms of purging. Because many
individuals with bulimia ‘binge and purge’ in secret and maintain normal or above normal
body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know.
Many individuals with the disorder can remain at normal body weight or slightly above.
Dieting heavily between episodes of binging and purging is also common.
As with anorexia, bulimia often begins during adolescence. The condition occurs most often
in women but is also found in men. Many individuals with bulimia may find themselves
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
ashamed of their habits, and may not seek help until they reach their thirties or forties. By
this time, their eating behaviour is deeply ingrained and more difficult to change.
Specific Symptoms of this Disorder
This disorder is characterised by recurrent episodes of binge eating, occurring at least twice
a month for a minimum of three months, which consists of:
Eating, in a discrete period of time (e.g., within any two-hour period), an amount of food that
is definitely larger than most people would eat during a similar period of time and under
similar circumstances. The food that is eaten is often the type which the person would
usually try to avoid – such as sweet or ‘junk’ food.
A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop
eating or control what or how much one is eating).
Individuals who have this disorder often try to prevent themselves from gaining any weight.
This behaviour may include such things as self-induced vomiting; overusing laxatives,
diuretics, enemas, or other medications; refusing to eat (fasting); or excessive exercise. A
person's self-image is usually directly correlated with their weight, with a great deal of
attention focusing on how their body looks.
This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.
There are two major sub-types of disorders found within bulimia nervosa:
Purging Type: - The person regularly engages in self-induced vomiting or the misuse of
laxatives, diuretics, or enemas.
Non-purging Type: - The person has used other inappropriate compensatory behaviours,
such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting
or the misuse of laxatives, diuretics, or enemas.
Physical Effects
 Chronic sore throat
 Burning or rupturing of oesophagus
 Cessation of menstruation
 Strain on the body organs
 Delay in puberty
 Decreased bone mineral density
 Swollen salivary glands
 Erosion of dental enamel due to constant purging
 Weight fluctuation
Treatment
A complete medical examination is usually warranted to evaluate the person's health and
medical status. Underweight or overweight individuals often experience other medical
complications, especially if the person is using laxatives or vomiting as a method of
controlling their over-eating behaviours. Psychotherapies are most effective when the focus
is not extensively on the actual eating behaviours, although these are important, but instead
examines the causes of those behaviours, such as poor self-perception and body image
distortions.
Medication
Some medications can be extremely helpful for a person who has bulimia. Medication should
be carefully monitored especially if the person may be vomiting or taking large amounts of
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
laxatives which may impact on the medication's use and effectiveness. A trusting and honest
relationship must be established between the physician and the individual or mediation
compliance will almost certainly become an issue.
Anti-depressants (selective serotonin re-uptake inhibitors such as Prozac or Zoloft) are a
common drug treatment and may speed up the recovery process. Phenytoin and
carbamazepine may also help reduce the frequency of the binging behaviours.
Self-Help
Self-help support groups are a particularly powerful and effective means of ensuring
engagement in long-term treatment and decrease the rate of relapse. Individuals find they
can share ideas and experiences, receive objective feedback about body image, and gain
increased social support. Many support groups exist within communities throughout the
world that are devoted to helping individuals with this disorder share their common
experiences and feelings.
Compulsive Overeating Disorder
People with compulsive overeating disorders are often not taken seriously in spite of the fact
that they have a serious eating disorder. Our society tends to glorify thinness whilst not
tolerating people who are obese. Overeating is characterised by episodes of gorging,
continuous eating and of weight gain. Please note, that there is a difference between
compulsive binging and the occasional overindulgence we can all enjoy occasionally. The
weight of a compulsive overeater may vary from normal to severe obesity. A person might
over exercise or engage in ‘compulsive exercising’ in an attempt just to burn calories and
lose weight. Often, they may sneak away behind closed doors to exercise in privacy. Where
the average person can enjoy exercising for health benefits, this person often does not and
seems to forget that exercising can be fun and enjoyable. By over exercising, they may
begin to feel they are in control and subsequently gain a sense of self-respect. Like anorexia
and bulimia, the person is driven and fuelled by their fear of gaining more weight. It is easy
to see how many over eaters can later develop bulimia or anorexia. Eating disorders are the
preoccupation with body shape, food, thinness and control and this may come as no surprise
when, in today’s world, we are all conditioned to want the perfect body and shape in which
we can feel good about ourselves and accepted in society.
Binge Eating Disorder
Binge eating disorders quite possibly affect millions of people, is the newest recognisable
eating disorder and perhaps even the most common. While people with bulimia are perfect
examples of binge eating, it is rare for people with binge eating disorders to purge (selfinduced vomiting) or use laxatives or diuretics. However, just because someone overeats
does not mean they have a binge eating disorder. People with binge eating disorders may
show behaviours or have feelings such as:
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Eating faster than usual.
Eating in privacy (usually over guilt and embarrassment about how much food is
being consumed).
Unable to control how much they eat.
Frequently eat when they are not hungry.
Experience episodes of eating large quantities of food.
Frequent feelings of disgust, self-hate or guilt after eating.
Most people with a binge eating disorder are obese. This is slightly more common in females
than males. It is even more common in those who have severe obesity. This disorder can be
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
very difficult for those who have it and many who attempt to control it are usually
unsuccessful.
There are times where people may not attend social functions, school or even work so they
stay in privacy to binge eat. Many people can feel embarrassed and ashamed and conceal
their problem from others thus making them feel isolated and even depressed. Since so
many binge eaters are preoccupied about their body weight and size, they may avoid or be
absent from family gatherings or social functions. Close friends and family members are
often unaware of the disorder.
Eating Disorders Not Otherwise Specified
Sometimes a person can experience symptoms of an eating disorder but not meet the
criteria for a diagnosis of anorexia, bulimia or compulsive overeating. The fact that they do
not meet recognised criteria does not mean that a problem may not exist. Many people have
disordered eating patterns, such as being overly concerned with eating healthily, or having
strict rituals around eating. If left untreated, such eating patterns can develop into disorders.
Where to Get Help?
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Your local GP.
Community Health Centre (under ‘Community Health Centres’ in the White Pages).
School counsellor or teacher.
The Centre for Eating and Dieting Disorders: (02) 9515 5843 or www.cedd.org.au
Telephone Counselling Services eg. Lifeline 131 114, Salvo Careline 02 9331 6000,
Kids Helpline 1800 551 800.
Mental Health Information Service 1300 794 991 (for services in your area).
The Butterfly Foundation on (02) 9412 4499 or www.thebutterflyfoundation.org.au
Many hospitals have Eating Disorder Units, contact them directly for details.
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Eating Disorders
ARAFMI NSW Inc.
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Eating Disorders – article by Emma Thomas
References:
Eating disorders costing billions, report says. (n.d.). Retrieved April 21, 2015, from
http://www.sbs.com.au/news/article/2015/03/02/eating-disorders-costing-billions
Information and Resources. (n.d.). Retrieved April 21, 2015, from
http://thebutterflyfoundation.org.au/facts-sheets/
Manocha, D. R. (n.d.). 5 Tips for Constructive Conversations with Your Child About Weight.
Retrieved April 21, 2015, from http://www.generationnext.com.au/2015/03/5-tips-forconstructive-conversations-with-your-child-about-weight/
Mental Illness Factsheets - Mental Heath Association NSW. (n.d.). Retrieved April 21, 2015,
from http://www.mentalhealth.asn.au/our-resources/mental-illness-factsheets
The National Eating Disorders Collaboration. Retrieved April 21, 2015, from:
http://www.nedc.com.au
http://www.arafmi.org/wp-content/uploads/2015/01/NSW-Mental-Health-Commission-LivingWell-A-Strategic-Plan.pdf
http://www.eatingdisorders.org.au
Australian Government Department of Health.Retrieved pril 21, 2015 from
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-a-anorextoc~mental-pubs-a-anorex-2#hos\
http://www.dsm5.org/documents/eating%20disorders%20fact%20sheet.pdf
Emma Thomas
Eating Disorders
ARAFMI NSW Inc.